L.M. v. Commissioner

Background

L.M. applied for Social Security disability insurance benefits and disabled widow’s benefits, alleging that complications from type 2 diabetes disabled her beginning January 1, 2020. The administrative law judge found her disabled beginning May 1, 2021, but not during the period from January 1, 2020, through April 30, 2021. Because the prescribed period for disabled widow’s benefits ended November 30, 2020, the earlier onset date mattered mainly to that claim.

The parties filed cross-motions for summary judgment. L.M. argued that the administrative law judge improperly found her bilateral proliferative diabetic retinopathy with macular edema non-severe, improperly discounted her symptom testimony, and assessed her residual functional capacity without supporting medical opinion evidence. The Commissioner defended the decision and argued that any remand should be for further proceedings.

Court’s Analysis

The court held that the administrative law judge erred in treating L.M.’s eye disease as non-severe. A retinal specialist diagnosed active diabetic retinopathy in both eyes with macular edema and treated it with injections approximately every six weeks. The medical records documented blurred vision, floaters, light sensitivity, difficulty focusing, and increased macular edema during the relevant period. The administrative law judge did not discuss those records, even though L.M.’s counsel identified them at the hearing.

The court also held that the eye-disease error was not harmless because the residual functional capacity contained no visual limitation, the decision did not address the ophthalmological evidence later in the analysis, and the past work identified by the administrative law judge required frequent near visual acuity. The alternative finding based on a full range of light work also did not account for possible non-exertional visual limitations.

The court separately held that the administrative law judge did not provide specific, clear, and convincing reasons for discounting L.M.’s symptom testimony. The decision relied on descriptions that L.M. was doing well and active and on the assertion that she spent two months in Mexico. But L.M. testified that the trip lasted two weeks, that she traveled with her brother, stayed at her mother’s house, rested, and was sick with low blood pressure for one of those weeks. The court found that the administrative law judge’s own questioning established the two-week duration and that the record showed she had returned for an eye injection shortly afterward.

The court also found that the decision selectively relied on treatment notes describing improvement without adequately considering other evidence from the same period, including hospitalizations, uncontrolled diabetes, escalating insulin treatment, continuing eye injections, and chronic diarrhea. The decision did not address important testimony about urgent bathroom needs, nausea, dizziness, difficulty concentrating, reliance on others for meals and chores, and inability to sustain even seated work. The court could not uphold the decision based on additional reasons the Commissioner offered in court but that the administrative law judge had not given in the decision.

Remedy and Disposition

The court rejected L.M.’s request for an immediate award of benefits. Although the administrative law judge gave legally insufficient reasons for rejecting some evidence, the record was not fully developed. No medical opinion assessed L.M.’s functioning during the relevant period, and conflicts remained between her testimony, treatment notes describing improvement, and an agency medical finding that there was no severe impairment before November 2020. The agency also needed to determine her residual functional capacity and the onset date within the prescribed period.

The court therefore directed the administrative law judge to obtain medical-expert evidence about L.M.’s functional capacity from January 1, 2020, through April 30, 2021, and to reevaluate the record, including the ophthalmological evidence, consistently with the order. Judge Laurel Beeler granted L.M.’s motion for summary judgment in part, denied the Commissioner’s cross-motion, reversed the Commissioner’s final decision, and remanded the case under sentence four of 42 U.S.C. § 405(g) for further administrative proceedings.